Ambulatory health care settings (those that see patients in an out-patient environment verses in an in-patient hospital environment) are ubiquitous in every developed society. In the United States, almost every ambulatory health care setting (clinic) has multiple health care providers who are assisted by a larger number of staff in providing care and administrating the clinic.
Providing health care is resource intensive endeavor. These resources include physicians, medical technicians, medical assistants, nurses, other clinical and administrative staff, extensive facilities (e.g., waiting rooms, exam rooms, offices), and various types of equipment (everything from simple scales to very expensive and complicated diagnostic equipment).
Patient encounters typically require the successive involvement of many staff members and the use of several aspects of the facility and types of equipment. Each person involved in this chain of care has a specific role and uses various resources. For example—when a patient arrives at the clinic they “check-in” with the receptionist and wait in the waiting room; the patient is then escorted by a medical assistant to an exam room where the assistant gathers information and leaves the patient; subsequently the patient is seen by a physician or other provider; after the exam the patient then “checks-out” with a staff person before leaving the clinic. When tests, labs, or other studies are necessary even more people and resources are involved.
In the illustration above, the receptionist typically uses a Practice Management System to register the patient, often prepares portions of the medical record for clinical staff (particularly where paper health records are used), and alerts the clinical staff of the patient's presence; the medical assistant typically assigns the exam room, gathers patient health information for the medical record, prepares the patient for the provider, and alerts the provider of the patient's presence and updated health status; the provider examines the patient, records health information in the health record, orders treatment or study, and communicates the patient status to the medical assistant; and the “check-out” person typically records the visit as complete in the Practice Management System and coordinates subsequent patient visits and provider ordered treatment or study. So in this illustration the following clinical elements were involved: receptionist, medical assistant, provider, “check-out” staff, practice management system, medical record, waiting room, exam room, “check-out” counter, and whatever resources were required to administer the provider-ordered treatment or study.
The providing of care, by its very nature, is private. Patients are examined in private rooms and usually by only one provider or staff person at a time. This means that when a provider or other clinic member is in with a patient they are not available to their co-workers. This makes the coordinating of care efforts and resources difficult, time consuming, and prone to problems.
Systems and methods for coordinating these resources are known in the art and vary significantly in their approach, attributes, and common use. These include what are commonly referred to as Practice Management Systems, Electronic Health (or Medical) Records, other clinical workflow tools, and all manner of manual systems.
While such systems offer some benefits they generally fail to assist the clinic in attaining better resource utilization, higher efficiencies, and greater operational effectiveness. Tools provided are rarely tailored to what the specific clinic member needs for their role and that specific patient, nor do they ease the ‘hand off’ of patient care from one clinic member to the next.
Most systems focus on specific elements of the patient or encounter (e.g. as appointment time, visit type, chief complaint, payer, provider, health information, and the like) and do not help the clinic staff recognize the patient as a person. Patients therefore are often not recognized by the clinic staff attending to them, even though in many cases they are repeat visitors. This generally depersonalizes the encounter for both clinic member and patient alike, reducing the quality of the experience for all.
Administrators responsible for managing clinical staff and resources are generally hamstrung in their efforts to manage clinical staff and resources by the absence or unavailability of information. Most managers have precious little information regarding efficiencies, utilization, and effectiveness of the clinic overall and individual elements specifically.
The status of all patients in the clinic (e.g. who's currently attending them, where they are physically, how long they have been waiting, how long they are likely to wait) is impossible or difficult to monitor and track. Consequently, management is often in a reactive mode and responding to problems that could have been avoided if better information had been available.
Digital (electronic) documentation systems in the health care environment are well known in the art. Such systems are commonly called Electronic Health Records (EHR) or Electronic Medical Records (EMR). While EHR systems have the promise to improve both the quality and the efficiency of provided health care, current Electronic Health Record systems are generally cumbersome to use and offer little workflow assistance to clinic members.
Despite the recognition that EHR systems are in many ways compelling, their use is still met with a certain degree of opposition, skepticism, and limited success. It is apparent that until providers are offered EHR systems that are easy to use and empower their ability to care for patients, such resistance will persist.
One barrier to the adoption of an EHR system is the user-friendliness, i.e. “intelligence” of the interface. Current EHR systems frequently error on the side of over-inclusion; seeking to make input screens and data displays generic across medical specialties and clinical roles. Additionally, the EHR system interface generally requires users to re-enter information that is already known or to navigate through multiple-unrelated screens before they arrive at the interface that requires the clinic member's attention. As a result, most EHR system interfaces seem to present all of the patient information to every user all of the time, i.e. they don't intelligently present the information by presenting only the most pertinent information for the specific user. The distinct disadvantage with this approach is that productive time is lost inputting unnecessary information or navigating through the screens in the EHR application. Moreover, because the views are complicated and data-dense they are difficult to read; often obscuring the important and pertinent information. Chaotic and illogical formats not only present irrelevant, private, personal health information to more users than necessary, they also increase the opportunity for error.
Another barrier to the adoption of an EHR system is the inability to actually manage the provision of health care efficiently because of the inherent clinical (that is, health data) bias of most Electronic Health Records. For example, how long a patient visit was, how long a procedure took, how long a patient was waiting in the waiting room before examination, and the like, are completely lost variables in the current EHR scheme. In the current dichotomy, the procedural aspects of providing care are viewed as different from the actual care that was provided. The uncoupled nature of the medical workflow with the actual clinical work-product makes consistent work management practically impossible. The disadvantage of prior EHR systems is that the opportunity to integrate medical workflow with the actual clinical work-product in the EHR is completely lost.
Thus there is a need in the art for a comprehensive clinical workflow application that can work as a stand alone application or integrate with an Electronic Health Record system to manage medical office workflow in a user-friendly and easily adoptable format. Such a system would provide electronic storage, retrieval, analysis, and transmittal of information and have the advantage, amongst other things, of completely integrating the clinical workflow environment, thereby reducing the duplication of effort, the number of systems and personnel necessary to do multiple tasks, and increasing efficiency and cost-effectiveness.